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ELEC ICAL PERMIT AP LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857- uti iv - d.� <br /> etlrtii ( .evere-F eO5 cVe'Ne-t a <br /> lLoC (7-- <br /> PROJECT ADDRESS <br /> A D 7t/ 15-0 Et, )L. c <br /> � L-�d � Z J <br /> Owner Mail Address City State/Zip Phone <br /> Giiil t`:)Ii)V t <br /> Tenant Mail Address City State/Zip Phone <br /> I ltpin t_A(7, ELGCZ.-T1t6- G r'r7)C t' t4l fav -"L4.Ji-iD q, i (,v'•C' ,S3 <br /> ( (7y) 2Z 20IZ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> i l'l1.E1'`i 7S <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) 'Tr C'us.(411.1 i Stu4vt.srL T•11,-)Lf,,V,(614,N <br /> Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: CE',Sfke 1-1L./ 0--q:TZA,,`r SMV i N t� '�;��iyy 7v-f_ cqp- L,tGriT S ) <br /> AA\r'' 1 I4Aj 2. Git'�ctr. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 SSD ba <br /> I hereby certify that I have read and examined this application and know the same to be true and r <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the /� <br /> performance of construction. That l am authorized by the owner of this property to perform the E �h Ic - <br /> 11161 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC.)7iTAA <br /> 47' <br /> °G ! 611 <br /> Signature t J <br /> ij Date <br /> REVISED 08/06/2014 3' . L.- -p J <br />